| Concierge Medical Inc | |
|
805 W Oak Ave Visalia CA 93291-6033 | |
| (559) 732-4362 | |
| (559) 732-4911 |
| Full Name | Concierge Medical Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 805 W Oak Ave, Visalia, California |
| Authorized Official Name and Position | Jaime Salvatierra (PA) |
| Authorized Official Contact | 5597324362 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Concierge Medical Inc 805 W Oak Ave Visalia CA 93291-6033 Ph: (559) 732-4362 | Concierge Medical Inc 805 W Oak Ave Visalia CA 93291-6033 Ph: (559) 732-4362 |
| NPI Number | 1194124586 |
|---|---|
| Provider Enumeration Date | 08/21/2014 |
| Last Update Date | 11/17/2022 |
| Medicare PECOS PAC ID | 5698099133 |
|---|---|
| Medicare Enrollment ID | O20150112000276 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194124586 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | C25735 (California) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| Provider Name | Sudesh Nagavalli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780629691 PECOS PAC ID: 9537114103 Enrollment ID: I20050316000568 |
| Provider Name | Laurie Hagopian-dresser |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578513610 PECOS PAC ID: 9638201833 Enrollment ID: I20100723000748 |
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